Objective: To characterize patients with early versus later levodopa exposure, defining “early” as within 2 years of Parkinson’s disease (PD) diagnosis, and to determine whether early exposure influences onset of motor complications.
Background: Optimal timing of levodopa initiation remains a contentious topic. Early use may improve quality of life, but fear of motor complications such as levodopa-induced dyskinesia delays utilization.
Method: To explore association between time of levodopa initiation and onset of motor complications, we analyzed data from the Parkinson’s Foundation Parkinson Outcomes Project, a large prospective multicenter database quality improvement initiative involving expert centers around the globe. We identified patients who entered the study within 2 years of diagnosis, had PD diagnostic certainty >90% at all visits, and were followed for ≥3 years. We compared patient baseline demographics, clinical features, and time to motor complications between those with early versus later levodopa exposure.
Results: We identified 738 patients of which 67% had early levodopa (n=491). Early users were exposed to levodopa within a mean of 1.4±0.7 years since PD diagnosis, compared to 4.5±1.5 years in later users (p<0.001). Early users were typically older (mean age 66±10 vs. 61±8 years, p<0.001), had longer disease duration (3.5±3.1 vs. 2.9±2.2 years, p<0.01), and worse PDQ39-mobility, cognitive and Hoehn and Yahr (HY) scores at baseline (all p<0.05). After controlling for demographic variables, HY stage, disease duration and comorbidities, early levodopa exposure was associated with earlier time to development of motor complications (mean 3.5±2.3 years vs 5.2±2.5 years; median 4.0 vs. 6.0 years, hazard ratio 2.2, p<0.0001). Older age and higher HY stage at baseline were associated with earlier development of motor complications. 99.6% of patients had motor complications by 11 years of diagnosis.
Conclusion: In this cohort, early levodopa exposure (within 2 years of PD diagnosis) was associated with earlier onset of motor fluctuations, controlling for disease duration.
To cite this abstract in AMA style:
S. Chiu, A. Ramirez-Zamora, B. Patel, S. Wu, H. Gao, O. Nguyen, I. Malaty. Early versus later levodopa and onset of motor fluctuations in PD: Observations from the Parkinson’s Outcomes Project [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/early-versus-later-levodopa-and-onset-of-motor-fluctuations-in-pd-observations-from-the-parkinsons-outcomes-project/. Accessed June 16, 2025.« Back to MDS Virtual Congress 2021
MDS Abstracts - https://www.mdsabstracts.org/abstract/early-versus-later-levodopa-and-onset-of-motor-fluctuations-in-pd-observations-from-the-parkinsons-outcomes-project/